Past Research Studies
1. The Healthy Living and Eating After Cancer Trial (2013-2016)
This randomized controlled trial investigated the ability of a 15-week diet and exercise program to help cancer survivors lose weight. Participants were randomized to a group-based weight loss program or a wait-list control group. Compared to the control group, participants in the weight loss program showed significant improvements in physical functioning, reduction in insomnia symptoms and sleep disturbance, and an average of 4.6 kg weight loss by week 15 that was maintained at week 30.
Publications:
- The effects of a clinic-based weight loss program on health-related quality of life and weight maintenance in cancer survivors: A randomized controlled trial (Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 2021)
2. LIVESTRONG at the YMCA (2013-2014)
This randomized controlled study investigated if a community-based fitness program could significantly improve the health and well-being of cancer survivors. By testing 186 participants across various YMCA locations, a 12-week supervised program successfully increased physical activity levels, boosted cardiorespiratory fitness, and enhanced overall quality of life without any safety concerns. The trial's most important takeaway was that high-quality cancer recovery support does not have to be limited to a hospital; instead, it can be effectively delivered through the broad network of neighborhood YMCAs, making essential rehabilitation much more accessible.
Publications:
- Effect of the LIVESTRONG at the YMCA exercise program on physical activity, fitness, quality of life, and fatigue in cancer survivors (Cancer, 2016)
3. Pre-Operative Health and Body (PreHAB) Study (2011-2015)
This randomized window of opportunity trial evaluated the impact of a pre-operative exercise intervention on tissue and serum biomarkers in women with early-stage breast cancer. Inactive women with newly diagnosed breast cancer were randomized to an exercise intervention or a mind-body control group. Results demonstrated that exercise did not alter cell proliferation but did impact tumor gene expression, particularly in pathways involved in inflammation and immune regulation. This trial provided some of the first evidence in humans that exercise directly affects breast cancer and insight into the biologic pathways through which exercise could impact breast cancer.
Publications:
- Impact of a pre-operative exercise intervention on breast cancer proliferation and gene expression: Results from the Pre-Operative Health and Body (PreHAB) Study (Clinical Cancer Research, 2019)
- Exploring the impact of exercise and mind–body prehabilitation interventions on physical and psychological outcomes in women undergoing breast cancer surgery (Supportive Care in Cancer, 2021)
4. Exercise and/or Metformin for Colorectal and Breast Cancer Survivors (2011-2013)
This randomized phase II clinical trial evaluated the impact of exercise and/or metformin on insulin and other metabolic biomarkers in breast and colorectal cancer survivors. After completing standard therapy, participants were randomized to exercise, metformin, both, or neither for 12 weeks. Both exercise and metformin reduced levels of fasting insulin, and participants randomized to both exercise and metformin experienced improvements in insulin resistance and other metabolic biomarkers. This study represents one of the first trials to evaluate the independent and combined effects of different interventions on metabolism and other mechanistic pathways hypothesized to underline the relationship between lifestyle factors and cancer.
Funding: National Cancer Institute
Publications:
- Randomized Phase II Trial of Exercise, Metformin, or Both on Metabolic Biomarkers in Colorectal and Breast Cancer Survivors (JNCI Cancer Spectr., 2020)
5. The Metastatic Exercise Training Trial (2006-2011)
This randomized controlled trial evaluated the feasibility and potential benefits of a 16-week moderate-intensity exercise program for women with metastatic breast cancer. Women were randomized to the exercise intervention with a goal of 150-minutes of moderate-intensity aerobic exercise per week or the wait-list control group. Participation in the exercise intervention did not result in significant improvements in physical functioning, suggesting that more tailored approaches are needed for this population.
Publications:
- Randomized trial of a physical activity intervention in women with metastatic breast cancer (Cancer, 2016)
6. Active After Cancer Trials (AACT) (2007-2009)
This multicenter pilot study evaluated the feasibility of a telephone-based exercise intervention in a cooperative group setting. Sedentary (engaging in <60 min of recreational activity/week) breast and colorectal cancer survivors were randomized to a telephone-based exercise intervention or usual care control group. Participants in the intervention group experienced statistically significant increases in fitness, physical functioning, quality of life, and fatigue.
Publications:
- Impact of a Telephone-Based Physical Activity Intervention upon Exercise Behaviors and Fitness in Cancer Survivors Enrolled in a Cooperative Group Setting (Breast Cancer Research and Treatment, 2011)
7. Mixed Strength and Endurance Exercise Intervention on Insulin Levels (2004-2006)
This randomized controlled trial investigated whether exercise could lower insulin levels in sedentary, overweight stage I-III breast cancer survivors. Participants were assigned to a 16-week cardiovascular and strength training exercise intervention or a usual care control group. Insulin levels significantly decreased within the exercise group, highlighting that a moderate-intensity, mixed-modality exercise program is a viable way for breast cancer survivors to improve their metabolic profile. Additionally, participants in the exercise group experienced a significant decrease in hip measurements but no change in weight or body composition, suggesting that metabolic health can improve through exercise even in the absence of significant weight loss.
Publications:
1. Mobility Disability in Cancer Survivors
Cao C, Yang L, Schmitz KH, Ligibel JA. Prevalence and cancer-specific patterns of functional disability among US cancer survivors, 2017-2022. J Clin Oncol. 2024 Jul 1;42(19):2257-70.
This analysis evaluated the prevalence and correlates of self-reported mobility disability (i.e., difficulty in walking or climbing) in 2,432,754 non-cancer adults and 47,768 cancer survivors from the 2017-2022 Behavioral Risk Factor Surveillance System (BRFSS). Results found that 27.9% of cancer survivors had a mobility disability. Risk factors for loss of function after cancer diagnosis included higher BMI, low physical activity level, residing in a rural or nonmetropolitan county, attaining lower levels of educational and/or income, having a history of cardiovascular disease or diabetes, and experiencing cancer-related pain.
2. Association of N-terminal Pro-Brain Natriuretic Peptide with Survival among US Cancer Survivors
Cao C, Yang L, Nohria A, Mayer EL, Partridge AH, Ligibel JA. Association of N-terminal pro-brain natriuretic peptide with survival among US cancer survivors. J Natl Cancer Inst. 2024 Jun 7;116(6):938-47.
This analysis investigated the relationship between N-terminal pro-brain natriuretic peptide (NT-proBNP), a known cardiac biomarker, and survival rates among US cancer survivors using a nationally representative sample from the National Health and Nutrition Examination Survey. NT-proBNP levels were significantly higher among cancer survivors compared to adults without a history of cancer (median 125.4 pg/mL vs. 43.2 pg/mL). Higher levels of NT-proBNP were strongly associated with increased risk of all-cause death and cardiac death among cancer survivors.
3. Diet, Exercise, and Weight in Oncology Care
Ligibel JA, Pierce LJ, Bender CM, Crane TE, Dieli-Conwright C, Hopkins JO, Masters GA, Schenkel C, Garrett-Mayer E, Katta S, Merrill JK, Salamone JM, Brewster AM. Attention to diet, exercise, and weight in oncology care: results of an American Society of Clinical Oncology national patient survey. Cancer. 2022 Jul 15;128(14):2817-25
This study assessed practice patterns related to weight, diet, and exercise as a part of cancer care through a national online survey in 2,419 cancer survivors. More than half of respondents reported that their providers asked about exercise (56.8%) and diet (50.1%), but only 28% discussed the connection between weight and cancer. When oncology providers gave specific recommendations, patients were significantly more likely to make positive lifestyle changes. For example, 79.6% of patients advised to exercise reported behavior changes, compared to 69% of those who received no advice. These findings underscore the critical need to increase formal referrals to specialists (dietitians and exercise programs) and ensure that third-party payers support these services.
Ligibel JA, Jones LW, Brewster AM, Clinton SK, Korde LA, Oeffinger KC, Bender CM, Tan W, Merrill JK, Katta S, Alfano CM. Oncologists' attitudes and practice of addressing diet, physical activity, and weight management with patients with cancer: findings of an ASCO survey of the oncology workforce. J Oncol Pract. 2019 Jun;15(6):e520-8.
This study investigated oncology provider practice patterns and perceptions regarding obesity and weight management during and after cancer treatment through an online survey administered to US oncology providers. Of the 917 respondents, most agreed that being overweight or obese affects cancer treatment outcomes and that the treating physician is responsible for recommending lifestyle changes. However, over 80% noted more training is needed to do so effectively. Other reported barriers to implementation included patient resistance, lack of time, and resource scarcity.
4. Obesity, Inactivity, and Cancer Outcomes
Ligibel JA, Huebner L, Rugo HS, Burstein HJ, Toppmeyer DL, Anders CK, Ma C, Barry WT, Suman V, Carey LA, Partridge AH, Hudis CA, Winer EP. Physical activity, weight, and outcomes in patients receiving chemotherapy for metastatic breast cancer (C40502/Alliance). JNCI Cancer Spectr. 2021 Apr 12;5(3):pkab025. PMID: 33981951; PMCID: PMC8103727
This analysis evaluated the relationships between obesity, inactivity, and cancer outcomes in patients enrolled in CALGB 40502, a randomized phase III trial of first-line taxane-based chemotherapy in 799 women with metastatic breast cancer. Results demonstrated that BMI and physical activity were not associated with progression-free or overall survival, however, patients with hormone receptor-positive disease who engaged in higher levels of physical activity had better outcomes than those who engaged in lower levels of activity.
5. Factors Associated with Body Weight Change
Sella T, Zheng Y, Tan-Wasielewski Z, Rosenberg SM, Poorvu PD, Tayob N, Ruddy KJ, Gelber SI, Tamimi RM, Schapira L, Come SE, Peppercorn J, Borges VF, Partridge AH, Ligibel JA. Body weight changes and associated predictors in a prospective cohort of young breast cancer survivors. Cancer. 2022 Sep 1;128(17):3158-3169.
This study evaluated weight change over time and factors associated with weight gain among young women recently diagnosed with breast cancer participating in the Young Women’s Breast Cancer Study (YWS), a multicenter, prospective cohort study that enrolled women aged 40 years within 6 months of diagnosis with in-situ or invasive breast cancer. Weight increased significantly but modestly over the 3 years following cancer diagnosis. Chemotherapy, endocrine therapy, and treatment-related menopause were not associated with weight change. The strongest predictor of weight gain over time was having less self-perceived financial comfort, highlighting the relationship between socioeconomic status and unfavorable lifestyle change in women with early breast cancer.
6. BMI and Breast Cancer Recurrence
Ligibel JA, Cirrincione CT, Liu M, Citron M, Ingle JN, Gradishar W, Martino S, Sikov W, Michaelson R, Mardis E, Perou CM, Ellis M, Winer E, Hudis CA, Berry D, Barry WT. Body mass index, PAM50 subtype, and outcomes in node-positive breast cancer: CALGB 9741 (Alliance). J Natl Cancer Inst. 2015 Sep;107(9).
This study explored the relationship between BMI at the time of breast cancer diagnosis and disease recurrence among women enrolled in C9741, a randomized clinical trial of adjuvant chemotherapy in women with stage II-III breast cancer. In multivariate models, a linear relationship between BMI at the time of breast cancer diagnosis and both disease-free and overall survival was observed, with a 1.5% increase in the risk of recurrence and mortality for each 1 unit of increased BMI (p=0.04). Additionally, women with obesity were more likely to be diagnosed with biologically aggressive cancers than women with lower BMI.